Pediatric Naegleria Treatment & Management

Updated: Sep 12, 2016
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

The medical care in patients with PAM is complicated by the rarity of the disease, the difficulty in diagnosing N fowleri infection early, and the fact that N fowleri is so rapidly lethal. Once clinical symptoms begin, the patient has a very short time during which therapy might be effective. The exceedingly high mortality rate of PAM suggests that many, if not most, patients have already entered into a stage that is not responsive to currently available therapy by the time they present for medical care.

The drug of choice (DOC) is amphotericin B. Lipid preparations of amphotericin B are not superior to conventional amphotericin B, and the lipid preparations have been shown to have higher minimal inhibitory concentrations. Other drugs that have been used include miconazole IV, which is not available in the United States, as well as rifampin, sulfonamides, chloramphenicol, and tetracycline. Miconazole may be useful and even synergistic with amphotericin B, but the other drugs are of questionable value.

In conjunction with the FDA, the CDC has an expanded access investigational new drug (IND) protocol in effect to make miltefosine available directly from the CDC for treatment of free-living amebae (FLA) in the United States. These infections include primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri and granulomatous amebic encephalitis caused by Balamuthia mandrillaris and Acanthamoeba species. [8]

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Surgical Care

In patients who develop life-threatening elevations in intracranial pressure, ventriculostomy and drainage of CSF may be necessary to relieve intracranial pressure. In one survivor, surgical drainage of a brain abscess was performed in addition to treatment with a 6-week course of amphotericin B, rifampicin, and chloramphenicol.

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Consultations

When the diagnosis of PAM is considered, appropriate considerations for consultations include an infectious disease specialist and a neurosurgeon.

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